Patient suicide is one of the primary sentinel events reported throughout the United States (22). In recognition that prevention of inpatient suicide should be a critical priority for systems of care, The Joint Commission designated the assessment of suicide a National Patient Safety Goal in 2007. Unfortunately, however, this task is hampered by a relative lack of scientific information for guidance with no systematic studies or recommendations for best practices (41). Thus, the proposed research aims to plan a patient safety and medical liability reform initiative that targets in-hospital suicides and suicide attempts. The initiative is aimed at developing and piloting an innovative model (Initiative to Reduce Inpatient Suicide;I.R.I.S) that combines Microsystem modeling (33) and Bundle concept (15). The I.R.I.S. model targets four key areas identified by Joint Commission (2007) as major contributors to suicide attempts and completed suicides in the hospital: Staff and Training;Patient Care;Environment Safety;and Incident Reporting. The study will compare the I.R.I.S. model to the current Standard of Care (SOC) model to evaluate effectiveness and feasibility of the I.R.I.S. model. Self- report questionnaires, clinical interviews, behavioral observation to test for protocol adherence, and focus groups will be the major means to gather data from inpatients and clinical staff. When comparing the I.R.I.S. model with the Standard of Care (SOC) model at Jackson Health System (JHS), it is hypothesized that five months after the implementation of the I.R.I.S. model, changes will be observed in the four components of the model that will lead to two significant outcomes: 1) Availability of psychometric proven methodology to empirically validate best practices on interventions aimed to reduce suicidality among inpatients;and 2) A refined I.R.I.S. model deemed more feasible and sustainable will be tested in a larger clinical trial to understand the impact of the specific components on suicide risk in order to create a cost-effective practice to improve patient safety and reduce suicide risks among inpatients. In addition, a parallel initiative to this study, Initiative to Reduce Inpatient Suicide - Medical Liability Reform (I.R.I.S.-M.L.R.), was purposely designed to gather information through surveys and focus groups from internal and external stakeholders to target the following aims:1) Generate recommendations of how medical liability can be restructured to improve the production and use of information about quality and safety;2) Investigate major patient safety failures (e.g., human factors, faulty systems, etc) 3) Determine how the implementation of the I.R.I.S. model can used in efforts to reform medical liability;and 4) Create a proposal for the formation of Healthcare Patient Safety and Medical Liability Reform Workgroups that can be replicated across communities and healthcare systems for the improvement of patient safety protocols. PUBLIC HEALTH RELEVANCE: The relevance of this study involves the immediate need to develop and test an innovative model, Initiative to Reduce Inpatient Suicide (I.R.I.S.), to reduce inpatient suicide at Jackson Health System (JHS). The objective of developing a solid approach and intervention is to proactively identify potential risks and facilitate process redesign to improve patient safety by reducing risk of inpatient suicide at JHS. The proposed research aims to identify medical liability considerations that may be afforded to healthcare facilities and/or systems that employ trainings and models such as I.R.I.S. to prevent and reduce inpatient suicide.